PURPOSE: To explore the political and economic dimensions of diabetes self-management for Mexican American adults. DESIGN: Critical ethnographic analysis of focus group data from caregivers and adults with diabetes. FINDINGS: Three themes were identified: diabetes self-management is tied to other mental and bodily states, family and neighborhood environments cause stress and prevent diabetes solutions, and hassles of the health care environment subvert self-management. DISCUSSION: Cultural constructs about diabetes merge with social-political forces in explaining diabetes. IMPLICATIONS: Cultural competence in diabetes care requires attention to the political economy of the disease and advocacy for healthful political and economic change.